Forms

Title	Description
2009 COVA Care Enrollment Form	2009-2010 Enrollment Form for COVA Care Participants and changes to your COVA Care Plan during Open Enrollment or mid-year qualifying events
Accident Report - Employee	Report an accident that occurs during work hours. Employee must complete the report and submit to Human Resources.
Address or Name Change	Notify HR of any address changes that may affect your W2 mailings.
Background History Check	Condition of employment at CVCC; required for all new hires
Cash Match Agreement	Direct your Virginia Cash Match employer contribution to your chosen participating provider. Submit the form to Human Resources.
Direct Deposit EPPI Card Enrollment	Effective August 1, 2008, required for all newly-hired and re-hired employees (excludes work-study students)Current employees (excluding work-study students) must participate in direct deposit or the EPPI Card Program by September 22, 2008.
Stop Direct Deposit	Direct Deposit Stop Payment
Educational Aid and Continuous Learning Form (VCCS-16)	Request educational aid for coursework.
Employee Work Profile (EWP)	Employee's duties and responsibilities
Extraordinary Contributor	Document and recognize an extraordinary contribution in performance of duties.
Family Medical Leave Request	Request FMLA.
Flexible Spending Account Reimbursement	Request reimbursement of FSA (medical expenses or child card).
Health Benefits Enrollment or Waiver	New employee COVA Care enrollment or medical insurance change due to mid-year qualifying event.
Health Care (Anthem) Reimbursement Claim	Request reimbursement for medical expense not filed directly by your medical provider.
I-9	All employees must complete Section 1 prior to or on the first day of work. Section 2 must be completed within 3 days of employment.
Notice of Improvement Needed	Needs improvement form
Leave of Absence Request	Leave request for all types of leave.
Part-Time Employees Time Sheet	Time sheet in Excel format for part-time employees.
Part-Time/Overtime Request	For new hire of part-time employee or request of overtime for full-time employee.
Probationary Progress Review	Six Month Probationary Progress Review
Virginia Retirement System Forms	All forms related to Virginia Retirement System
Salary Reduction Agreement	Authorization for payroll deductions
Full-Time Employee Timesheet
VACU Membership	Virginia Credit Union membership application
VCCS-29	VCCS criteria for faculty rank and promotion
Virginia State Application Form (pdf) Virginia State Application Form (Word format)	PDF and Word format
VA-4 (Virginia Tax Form)	Submit completed form to Human Resources.
W-4 (Federal Tax Form)	Submit completed form to Human Resources